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HomeMy WebLinkAbout1.00 General Application Materials_Part17ACCESS ROAD MAP DRAWN BY SURVEYED BY WORKING PAD SURFACE UELS, LLCCorporate Office * 85 South 200 EastVernal, UT 84078 * (435) 789-1017ENGINEERING & LAND SURVEYING 80 0 ' 40 0 ' 0'80 0 ' OIL & GAS LOCATION (LOD) LEGEND ELK WINTER CONCENTRATION AREA NOTE: - PARCEL DATA SHOWN HAS BEEN OBTAINED FROM VARIOUS SOURCES AND SHOULD BE USED FOR MAPPING, GRAPHIC AND PLANNING PURPOSES ONLY. NO WARRANTY IS MADE BY UINTAH ENGINEERING AND LAND SURVEYING (UELS) FOR ACCURACY OF THE PARCEL DATA. - NO EXISTING RESIDENTIAL BUILDING UNITS WITHIN 2000' OF THE EXISTING ACCESS ROAD. PROPOSED ADDITIONAL ACCESS ROAD PROPERTY LINE 2000' OFFSET FROM EXISTING & PROPOSED ACCESS ROADS CO U N T Y R O A D 2 1 1 T6S R 98 W 16 15 109 AQUATIC SPORTFISH MANAGEMENT WATERS ELK SEVERE WINTER RANGE SCALE 1" = 500'T.L.L.07-10-23 DAYTON SLAUGH 06-29-23 EXISTING LOCATION: SKR #698-10-BV PAD PROPOSED ADDITIONAL ACCESS ROAD 140' +/- 1 2 EXISTING 18" CULVERT EXISTING GATE 1 2 SKR #698-10-BV PADTRACT 72, SECTIONS 10 & 15, T6S, R98W, 6th P.M.GARFIELD COUNTY, COLORADO CHEVRON U.S.A. INC. EXISTING ACCESS ROAD EXISTING ACCESS ROAD 388' +/- C L E A R C R E E K R O A D MAHOGANY ENERGY RESOURCES LLC CHEVRON USA INC BLM CHEVRON USA INC MAHOGANY ENERGY RESOURCES LLC CHEVRON USA INC CHEVRON USA INC CHEVRON USA INC MAHOGANY ENERGY RESOURCES LLCCHEVRON USA INC S E C T I O N L I N E SECTION LINE REV: 3 11-16-23 T.L.L. (UPDATE LOD) 658 PROPOSED HAUL ROUTE 4.2 Mi. ± HAUL ROUTE MAP SKR #698-10-BV PADTRACT 72, SECTIONS 10 & 15, T6S, R98W, 6th P.M.GARFIELD COUNTY, COLORADO CHEVRON U.S.A. INC. ENGINEERING & LAND SURVEYING UELS, LLC Corporate Office * 85 South 200 East Vernal, UT 84078 * (435) 789-1017 EXISTING LOCATION LEGEND: 20 0 0 ' 10 0 0 ' 0'20 0 0 ' T7S T6S EXISTING LOCATION: SKR #698-10-BV PAD R 98 W CL E A R C R E E K R D 4. 1 M I . + / - EXISTING ACCESS RD 0.1 MI. +/- CO U N T Y R D 2 0 4 REV: 2 11-07-23 T.L.L. (ADD ACCESS ROAD) RESIDENTIAL BUILDING UNIT DRAWN BY SURVEYED BY SCALE 1" = 2000'T.L.L.03-22-23 DAYTON SLAUGH 06-29-23 D E B E Q U E 1 2 . 5 M I . + / - EXISTING COUNTY RD 211 PROPOSED ACCESS ROAD 140' ± SEE DETAIL "A" DETAIL "A"N.T.S. PROPOSED ACCESS ROAD 140' ± EXISTING ACCESS RD 0.1 MI. +/- EXISTING COUNTY RD 211 CLEAR CREEK 0.1 MI. +/- 0.1 MI. +/- EXISTING SKR #698-10-BV PAD 659 Dust Mitigation Plan Date: 11/10/2023 Location: OGDP SKR-698-10-BV / SKR-698-10-BV Pad Legal Description: Tract 72, SWSW Section 10 & NWNW Section 15, Township 6S, Range 98W, 6th PM, Garfield County, Colorado 660 Location Information This document provides site-specific information for the SKR 698-10-BV (Skinner Ridge) Pad (referred to as the “Pad”) located within the OGDP SKR 698-10-BV. A pre-application meeting with Garfield County, CDPHE, ECMC, CPW, and Chevron was held on October 12, 2023. This application will be an amendment to the existing SKR-66S98W/10 SWSW Pad, permitted with ECMC under location ID #336056. This Pad was initially permitted for the drilling and completion of 22 wells; however, those wells were never drilled. Instead, the location was utilized as the Skinner Ridge Storage Facility, permitted by both ECMC, under location ID #447846, and Garfield County, under permit LIPA 6428. The information in this document relates specifically to the time during the construction, drilling, completion, and production of the two (2) proposed horizontal wells on the well pad portion of the location and the construction and operation of the facility portion of the location, which will receive production from the two wells. Additionally, a pilot hole for geothermal testing will be drilled in one of the wells, but the pilot hole will be plugged prior to drilling the horizontal leg of the well. The existing location is located off Garfield County Road 211 (Clear Creek Road) approximately 16.7 miles northwest of De Beque, Colorado. The Pad lies on Tract 72, and is situated on two sections, the SWSW of Section 10 and the NWNW of Section 15, Township 6 South, Range 98 West, 6th P.M. zoned Resource Lands per Garfield County. The existing Skinner Ridge Storage Facility disturbance area is 6.2 acres, and an additional 0.7 acres of disturbance is proposed for construction of stormwater detention ponds and drainage channel at the SKR 698-10-BV Pad. The working pad surface (WPS) will be 3.8 acres. The Pad disturbance area will be reduced to 2.3 acres during interim reclamation. The Pad is located on Garfield County Parcel 213732100008 owned by Chevron U.S.A., Inc. The location is currently used as a storage yard and all storage equipment and facilities will be relocated prior to drilling the proposed wells. The wells on the SKR 698-10-BV Pad will produce to the proposed production facility portion of the location and be tied into Chevron’s existing Central Production Facility (CPF) via a proposed gas and liquids line. Proposed equipment on the Pad will include separators, pigging stations, a gas meter, pipe skid, an instrument air skid, a skid drain vault, a chemical injection skid, a communication tower, solar skids, a maintenance tank, heat trace equipment, a transformer or electric generators, switchracks, and a battery box. A temporary MLVT, located on the nearby Skinner Ridge-66S98W/22NENW Pad (Location ID# 324358), will be utilized for completion operations. Phase Duration (days) Estimated Start Date Construction (Daylight Only) 10 days 2nd Quarter 2024 Drilling 80 days 3rd Quarter 2024 Completion 23 days 3rd Quarter 2025 Flowback N/A Flowing back directly to permanent facility Production 30 years 3rd Quarter 2025 Interim Reclamation (Daylight Only) 60 days 2nd Quarter 2026 661 Potentially Impacted Parties The Working Pad Surface (WPS) of the SKR 698-10-BV Pad is within 2,000 feet of zero (0) Residential Building Units (RBUs), zero (0) High Occupancy Building Units (HOBUs), and zero (0) Designated Outside Activity Areas (DOAAs). The Pad is located within a Disproportionately Impacted Community (DIC). The location is within ECMC designated High Priority Habitat (HPH) per rule 1202.d for Elk Winter Concentration Area and Elk Severe Winter Range and rule 1202.c for Aquatic Sportfish Management Waters. Dust Mitigation Plan Specific Data Soils Pad Soil type(s), 6.9 Disturbed Acres (including 6.2 acres of existing Storage Facility): • 44 - Happle very channery sandy loam, 3 to 12 percent slopes; 46 - Happle-Rock outcrop association, 25 to 65 percent slopes Access Road Soil type(s)*, 0.1 Disturbed Acres: • 44 - Happle very channery sandy loam, 3 to 12 percent slopes; Flowline Corridor Soil type(s)*, 9.5 Disturbed Acres: • 28 - Cumulic Haploborolls, 1 to 3 percent slopes; 44 - Happle very channery sandy loam, 3 to 12 percent slopes; 45 - Happle very channery sandy loam, 12 to 25 percent slopes; 46 - Happle-Rock outcrop association, 25 to 65 percent slopes *NRCS data is not accurate at scale for access roads and flowline corridor. Total area of soil disturbance: 16.4 acres. The existing and proposed access roads are unpaved for approximately 0.2 combined acres before entering unpaved Garfield County Road 211 (Clear Creek Road). Truck Traffic and Cumulative Dust Impacts The table below estimates the number of anticipated truck trips for this location and the combined trips for the entirety of OGDP SKR-698-10-BV, which only includes the SKR-698-10-BV Pad. The trip counts are further divided by individual phase of field operation. Operations for the Pad will convey traffic along Garfield County Road 211 (Clear Creek Road). The daily number of trips will typically be split evenly amongst each day of an operation’s duration. However, the heaviest periods of vehicle traffic will occur during the first two and last two days of both drilling and completions, when additional equipment mobilization will occur. During these days, the trips per day will increase by approximately 80 Heavy Truck Trips and 40 Light Truck Trips. The production phase trips will encompass regular operations and maintenance over a period of 30 years. 662 SKR-698-10-BV Pad Baseline Traffic Summary Phase Heavy Truck Trips per Location Light Truck Trips per Location OGDP SKR-698-10- BV Pad Cumulative Trips Construction 207 98 305 Drilling 6,944 7,164 14,108 Completions 2,512 1,438 3,950 Interim Reclamation 465 50 515 Production* 0 10,950 10,950 *Note: Production trips will be combined for multiple locations within the Piceance Basin whenever possible. The expected travel route for the proposed oil and gas location is indicated on the attached Access Road Map. The travel distribution from the proposed oil and gas location will convey all traffic along Garfield County Road 211 (Clear Creek Road). Mitigation Measures and Best Management Practices Chevron shall employ practices for control of fugitive dust caused by their operations. Such practices shall include but are not limited to the use of speed restrictions, regular road maintenance, pipeline infrastructure to provide takeaway for oil, gas, and produced water (reducing number of trips from heavy trucks), silica dust controls when handling sand used in hydraulic fracturing operations1, and restriction of construction activity during high-wind days. The location will also feature automation of wells and production and this OGDP was designed around consolidation of production facilities, reducing excessive driving on undeveloped or unpaved roads. Chevron additionally has implemented the use of traffic signs when leaving the location to remind drivers of specific routes to utilize. • When Chevron is required to suppress dust, its selected vendor will be reminded of the following: o Use only fresh water sources (non-potable) when watering areas within 300 feet of the ordinary high-water mark of any water body. o Maintain a current Safety Data Sheet (SDS) in their company vehicle when using a dust suppressor containing chemicals, in accordance with OSHA Standard 29 CFR 1910.1200 (Hazard Communication) as well as local and State requirements. o Ensure watering practices are not creating additional hazards on access roads (slick roads, muddy conditions, etc.). • All soil piles created by construction activities will be managed utilizing Hydro-mulch, straw crimping, and/or tracking methods to prevent dust from exiting the location and creating a hazard during pre-production activities. Soil piles will be graded and/or seeded to prevent erosion and the generation of dust post-production. 1 Silica dust control will include dust suppression with non-potable water, well-ventilated work site, pre-planned personnel rotation of work site, as well as other recommended measures included in OSHA Standard 29 CFR 1926.1153 Respirable Crystalline Silica. 663 • Chevron will minimize the amount of fugitive dust using speed restrictions. All vehicles will be subject to a speed limit of 20 MPH on all lease roads to minimize dust. • Chevron will mitigate the creation of fugitive dust through regular road maintenance as coordinated through agreements with Garfield County and any Relevant Local Governments or Agencies with road jurisdiction. • Chevron will use methods including wind breaks and barriers, road or facility surfacing, and soil stockpile stabilization measures to suppress fugitive dust caused solely by wind. • Chevron will avoid the creation of fugitive dust by restricting or limiting construction activity during high wind days. • Chevron will minimize fugitive dust caused by operations or dust originating from areas disturbed by previous operations that becomes windborne by utilizing the dust suppression methods mentioned above. • Chevron will not use any of the following fluids for dust suppression: o Produced water o E&P waste or hazardous waste o Crude oil or any oil specifically designed for road maintenance o Chemical solvents o Process fluids • Access road(s) will be watered or treated with one of the following commercial dust suppressants, as needed: o Roadsaver (magnesium chloride) o Roadsaver Compaction Aid (magnesium chloride) o DuraBlend (magnesium chloride) • Prior to the application of dust suppressant to any county or public roads, coordination will be conducted with Garfield County Department of Public Works by Chevron and any relevant vendors. • Chevron will maintain safety data sheets (“SDS”) for any chemical-based dust suppressant and make the SDS immediately available upon request to the ECMC Director, Garfield County, and to any other Local Government or Agency. Safety Data Sheet(s) for any chemical-based dust suppressant will be archived and maintained until the site passes final site Reclamation and transfer the records upon transfer of property ownership. • All secondary roads created for this project (non-public roadways) will be finished with ½” – ¾” crushed stone road base. 664 • Silica dust from handling sand used in hydraulic fracturing operations will be mitigated by utilization of the enclosed Sand Box delivery systems. As such, no pneumatic transportation of sand will be conducted at this location. • Chevron will take all necessary and reasonable precautions to ensure that dust from the Oil and Gas Location does not unnecessarily impact the health, safety, and welfare of Wildlife occupying any High Priority Habitat within 2,000 feet of the Oil and Gas Location. These actions include: o Identify permanent and temporary housing of resident wildlife and ensure locations are recorded in wildlife reports kept in-house by HSE. o Conduct a daily walkthrough of the location during ongoing operations to ensure no wildlife have built nest(s) in/around equipment. If nest(s) are found, HSE reporting will be issued to appropriate personnel to either remove the nest and/or temporarily abandon the equipment until nest is abandoned. Supplemental Information Chevron will occasionally reach out to third-party vendors to help ensure compliance with all applicable standards. Below is the list of vendors who have been selected: Vendors • Envirotech Services, Inc. 3860 N. Revere St., Suite C 303.903.6079 Exhibits/References/Appendices Access Road Map 665 ACCESS ROAD MAP DRAWN BY SURVEYED BY WORKING PAD SURFACE UELS, LLCCorporate Office * 85 South 200 EastVernal, UT 84078 * (435) 789-1017ENGINEERING & LAND SURVEYING 80 0 ' 40 0 ' 0'80 0 ' OIL & GAS LOCATION (LOD) LEGEND ELK WINTER CONCENTRATION AREA NOTE: - PARCEL DATA SHOWN HAS BEEN OBTAINED FROM VARIOUS SOURCES AND SHOULD BE USED FOR MAPPING, GRAPHIC AND PLANNING PURPOSES ONLY. NO WARRANTY IS MADE BY UINTAH ENGINEERING AND LAND SURVEYING (UELS) FOR ACCURACY OF THE PARCEL DATA. - NO EXISTING RESIDENTIAL BUILDING UNITS WITHIN 2000' OF THE EXISTING ACCESS ROAD. PROPOSED ADDITIONAL ACCESS ROAD PROPERTY LINE 2000' OFFSET FROM EXISTING & PROPOSED ACCESS ROADS CO U N T Y R O A D 2 1 1 T6S R 98 W 16 15 109 AQUATIC SPORTFISH MANAGEMENT WATERS ELK SEVERE WINTER RANGE SCALE 1" = 500'T.L.L.07-10-23 DAYTON SLAUGH 06-29-23 EXISTING LOCATION: SKR #698-10-BV PAD PROPOSED ADDITIONAL ACCESS ROAD 140' +/- 1 2 EXISTING 18" CULVERT EXISTING GATE 1 2 SKR #698-10-BV PADTRACT 72, SECTIONS 10 & 15, T6S, R98W, 6th P.M.GARFIELD COUNTY, COLORADO CHEVRON U.S.A. INC. EXISTING ACCESS ROAD EXISTING ACCESS ROAD 388' +/- C L E A R C R E E K R O A D MAHOGANY ENERGY RESOURCES LLC CHEVRON USA INC BLM CHEVRON USA INC MAHOGANY ENERGY RESOURCES LLC CHEVRON USA INC CHEVRON USA INC CHEVRON USA INC MAHOGANY ENERGY RESOURCES LLCCHEVRON USA INC S E C T I O N L I N E SECTION LINE REV: 3 11-16-23 T.L.L. (UPDATE LOD) 666 667 668 APPENDIX D  PERMIT APPLICATION   FORMS AND AGREEMENTS  SKR 698‐10‐BV Pad  Township 6 South, Range 98 West, 6th PM  Sections 10 & 15: Tract 72  Garfield County, Colorado  Revised 4-26-24 Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com LAND USE CHANGE PERMIT APPLICATION FORM TYPE OF APPLICATION Administrative Review Development in 100-Year Floodplain Limited Impact Review Development in 100-Year Floodplain Variance Major Impact Review Code Text Amendment Amendments to an Approved LUCP LIR MIR SUP Rezoning Zone District PUD PUD Amendment Minor Temporary Housing Facility Administrative Interpretation Vacation of a County Road/Public ROW Appeal of Administrative Interpretation Location and Extent Review Areas and Activities of State Interest Comprehensive Plan Amendment Accommodation Pursuant to Fair Housing Act Pipeline Development Variance Oil & Gas Development Oil & Gas Development Amendment Time Extension (also check type of original application) INVOLVED PARTIES Owner/Applicant Name: ________________________________________________ Phone: (______)_________________ Mailing Address: ______________________________________________________________________ City: _______________________________________ State: _______ Zip Code: ____________________ E-mail:_______________________________________________________________________________ Representative (Authorization Required) Name: ________________________________________________ Phone: (______)_________________ Mailing Address: ______________________________________________________________________ City: _______________________________________ State: _______ Zip Code: ____________________ E-mail:_______________________________________________________________________________ PROJECT NAME AND LOCATION Project Name: _____________________________________________________________________________________ Assessor’s Parcel Number: ___ ___ ___ ___ - ___ ___ ___ - ___ ___ - ___ ___ ___ Physical/Street Address: ________________________________________________________________ Legal Description: ______________________________________________________________________ _____________________________________________________________________________________ Zone District: ___________________________________ Property Size (acres): __________________ Revised 4-26-24 PROJECT DESCRIPTION Existing Use: __________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Proposed Use (From Use Table 3-403): _____________________________________________________ Description of Project: __________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ REQUEST FOR WAIVERS Submission Requirements The Applicant requesting a Waiver of Submission Requirements per Section 4-202. List: Section: ______________________________ Section: _________________________________ Section: ______________________________ Section: _________________________________ Waiver of Standards The Applicant is requesting a Waiver of Standards per Section 4-118. List: Section: ______________________________ Section: _________________________________ Section: ______________________________ Section: _________________________________ I have read the statements above and have provided the required attached information which is correct and accurate to the best of my knowledge. ______________________________________________________ __________________________ Signature of Property Owner or Authorized Representative, Title Date OFFICIAL USE ONLY File Number: __ __ __ __ - __ __ __ __ Fee Paid: $_____________________________ Revised 4-26-24 PAYME NT  AGREEMENT FORM  Revised 4-26-24 PAYMENT AGREEMENT FORM GARFIELD COUNTY (“COUNTY”) and Property Owner (“APPLICANT”) ______ ____ ______________________________________________________________________ agree as follows: 1.The Applicant has submitted to the County an application for the following Project: __________________. 2. The Applicant understands and agrees that Garfield County Resolution No. 2014-60, as amended, establishes a fee schedule for each type application, and the guidelines for the administration of the fee structure. 3. The Applicant and the County agree that because of the size, nature or scope of the proposed project, it is not possible at this time to ascertain the full extent of the costs involved in processing the application. The Applicant agrees to make payment of the Base Fee, established for the Project, and to thereafter permit additional costs to be billed to the Applicant. The Applicant agrees to make additional payments upon notification by the County, when they are necessary, as costs are incurred. 4. The Base Fee shall be in addition to and exclusive of any cost for publication or cost of consulting service determined necessary by the Board of County Commissioners for the consideration of an application or additional County staff time or expense not covered by the Base Fee. If actual recorded costs exceed the initial Base Fee, the Applicant shall pay additional billings to the County to reimburse the County for the processing of the Project. The Applicant acknowledges that all billing shall be paid prior to the final consideration by the County of any Land Use Change or Division of Land. I hereby agree to pay all fees related to this application: Billing Contact Person:_____________________________________ Phone: (_____)___________________ Billing Contact Address: ___________________________________________________________________ City: ______________________________________________ State: _______ Zip Code: ________________ Billing Contact Email: _____________________________________________________________________ Printed Name of Person Authorized to Sign: ___________________________________________________ ______ ________________________________ (Signature) (Date) Revised 4-26-24 STATEMENT OF AUTHORIZATION FORM  (Chevron has provided a recorded Power of AƩorney in lieu of the  AuthorizaƟon Form; A leƩer of authorizaƟon is also included.)  Revised 4-26-24 Ryan Antonio  Surface Land Manager Chevron Rockies Business Unit 2115 117th Avenue, Greeley, Colorado 80634 February 26, 2024  Garfield County   Community Development  108 8th Street, Suite 401  Greeley, Colorado 81601  RE:  Authorization to Represent Chevron for Garfield County Permitting Matters  To Whom it May Concern:  This letter is being submitted to authorize the following Chevron U.S.A. Inc. personnel and/or  contractors to represent Chevron in regulatory and permitting matters in Garfield County, Colorado    Doug Dennison  Manager, Development Permitting  Rockies Business Unit  2115 117th Ave  970‐270‐2853  dougdennison@chevron.com  Tracey Fallang  Contract Regulatory Specialist  Rockies Business Unit  2115 117th Ave  303‐596‐4818  tracey.fallang@chevron.com  If you should have any questions regarding this notice, please feel free to contact the undersigned  at 303‐913‐8156 or via email at ryan.antonio@chevron.com.  Thank you for your consideration of this matter.   Respectfully,  Ryan Antonio  Surface Land Manager  Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 NOTIFICATION PACKAGE  (names/mailing addresses) Revised 4-26-24 LUDC ARTICLE 9‐208 & 4‐101.E NOTICE RECIPIENTS Owner / Contact Mailing Address Type BUREAU OF LAND MANAGEMENT 2300 RIVER FRONTAGE ROAD  SILT, CO 81652 Adjacent Property Owner within 200' MAHOGANY ENERGY RESOURCES LLC 420 FIFTH AVENUE, 5TH FLOOR  NEW YORK, NY 10018 Adjacent Property Owner within 200' ENERGY & CARBON MANAGEMENT COMMISSION ‐ DIRECTOR JULIE MURPHY 1120 LINCOLN STREET, SUITE 801, DENVER, CO 80203 Director of the ECMC GARFIELD COUNTY ‐COMMUNITY DEVELOPMENT DEPARTMENT KIRBY WINN 108 8TH STREET, SUITE 401, GLENWOOD SPRINGS, CO 81601 Oil and Gas Liasion TYLER BINGER 9613 COUNTY ROAD 204, DE BEQUE, CO 81630 Tenant JOEL FOGELSANGE 9401 COUNTY ROAD 204, DE BEQUE, CO 81630 Tenant Notes:   Chevron is the sole mineral interest owner. There are no building units within 2,000' of the Pad. Revised 4-26-24         OWNERSHIP DEED  (Chevron U.S.A. Inc. is the surface owner)  Revised 4-26-24 OWNERSHIP DEED Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24 Revised 4-26-24         MINERAL OWNERSHIP CERTIFICATION  Revised 4-26-24 CERTIFICATION OF MINERAL OWNER RESEARCH This form is to be completed and submitted with any application for a Land Use Change Permit. Mineral interests may be severed from surface right interests in real property. C.R.S. § 24-65.5-101, et seq, requires notification to mineral owners when a landowner applies for an application for development from a local government. As such, the landowner must research the current owners of mineral interests for the property. The Garfield County Land Use and Development Code of 2013 (“LUDC”) Section 4-101(E)(1)(b)(4) requires written notice to owners of mineral interests in the subject property in accordance with C.R.S. § 24-65.5-101, et seq, “as such owners can be identified through the records in the office of the Clerk and Recorder or Assessor, or through other means.” This form is proof of applicant’s compliance with the Colorado Revised Statutes and the LUDC. The undersigned applicant certifies that mineral owners have been researched for the subject property as required pursuant to C.R.S. § 24-65.5-101, et seq, and Section 4-101 (E)(1)(b)(4) of the Garfield County Land Use and Development Code, as amended. As a result of that research, the undersigned applicant certifies the following (Please initial on the blank line next to the statement that accurately reflects the result of research): I own the entire mineral estate relative to the subject property; or Minerals are owned by the parties listed below The names and addresses of any and all mineral owners identified are provided below (attach additional pages as necessary): Name of Mineral Owner Mailing Address of Mineral Owner I acknowledge I reviewed C.R.S. § 24-65.5-101, et seq, and I am in compliance with said statue and the LUDC. _____________________________________________ _________________________________ Applicant’s Signature Date Revised 4-26-24         EVIDENCE OF LIABILITY INSURANCE  (Chevron is self‐insured; leƩer aƩached)  Revised 4-26-24 Revised 4-26-24 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Chevron U.S.A. Inc. 2115 117th Ave Greeley, CO 80634 RE: SKR 698-10-BV Oil and Gas Permit Additional Insured in favor of Certificate Holder and Board of County Commissioners on General Liability and Excess Liability as required by written contract subject to policy terms and conditions. Garfield County 108 8th Street Glenwood Springs, CO 81601 04/25/2024 1-877-945-7378 1-888-467-2378 certificates@wtwco.com Old Republic Insurance Company 24147 W33314809 A 1,000,000 100,000 10,000 1,000,000 2,000,000 2,000,000 Y MWZZ316714 03/01/2022 03/01/2025 A 1,000,000 Y MWZX316724 03/01/2022 03/01/2025 1,000,000 343628525773400SR ID:BATCH: WTW Certificate Center Page 1 of 1 Revised 4-26-24 APPENDIX F TOPOGRAPHIC MAP SKR 698‐10‐BV Pad  Township 6 South, Range 98 West, 6th PM  Sections 10 & 15: Tract 72  Garfield County, Colorado